Surrogacy 101 – Look before you leap

As a favor to those who find their way here by Googling for information on surrogacy, I'm breaking this down to the ultimate basics and writing as if my usual audience 1. doesn't already know more than anyone should ever have to about infertility, or 2. isn't already a surrogate or an intended parent. This introductory post will only set the framework for the basics; in the coming posts, I'll delve deeper into the emotional and technical aspects mentioned below.

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The first step of starting a surrogacy journey isn't placing an ad or signing with an agency; the first step is educating yourself about the surrogacy process and making several decisions as an individual or couple, and then making the dive into surrogacy. It might seem that this is a no-brainer, but it is not uncommon for some prospective intended parents (IPs) and surrogates to jump right into trying to find a match before they even understand the process. Some can't even spell the word (hint: there is no "n" in surrogacy, but there are two in pregnant. Do not post an ad that says something to the effect of "Surrogant 2 get pregnate for U." I'm just sayin').

Traditional vs. Gestational Surrogacy

The most basic thing to learn about surrogacy
is that there are two types: traditional surrogacy (TS) and gestational
surrogacy (GS).

Traditional surrogates conceive through artificial insemination of
the intended father's (IF) sperm, either through basic home
insemination or through a clinic intrauterine insemination (IUI).In traditional
surrogacy, the TS is genetically the mother of baby, and is, in
essence, the baby's birth mother.

Gestational surrogates (GS) conceive through IVF transfer of developing embryos. In this case, the surrogate is not
related to the baby. Most embryos in a GS arrangement are formed from
the intended mother's (IM) eggs and the IF's sperm. Though the baby is carried by
a surrogate, he or she is completely the genetic offspring of his
or her parents.

Sometimes there is a problem with the IM's egg quality, so a
fourth party – an egg donor (ED) – is included in the surrogacy process. Conversely, if male-factor infertility is an issue, a sperm donor could be used in a GS arrangement.

In a fewer number of instances, a set of intended parents
(IP's) will both have such extensive infertility that they
choose to adopt already fertilized embryos from another couple, or both donor eggs and sperm are used.

There are even instances of traditional surrogacy via IVF (TS/IVF). 


Pros and Cons to TS and GS

Traditional surrogacy is less-invasive, less time-consuming, and for IPs, is less-expensive. The central challenge of deciding on traditional surrogacy involves genetics. For a potential TS, this means deciding whether or not she could part with a baby that is genetically hers. For perspective TS IPs, this means feeling comfortable with the knowledge that the child their surrogate carries is her genetic offspring.

Gestational surrogacy alleviates the genetic challenges that are present in traditional surrogacy. The biggest hurdles for gestational surrogacy are the invasive
screening procedures, hormone injections and medications, and overall
extended length of the entire process. Additionaly, for intended parents, gestational surrogacy adds costly clinic fees that aren't necessary in traditional surrogacy.

Agency or Independent

Before a match is found, how that match is found should be determined —
either through a surrogacy agency or independently (indy). Through an agency, there
is a third party who helps surrogates and intended parents navigate their surrogacy journeys from matching through to the delivery. In indy journeys, surrogates and IPs navigate the entire process themselves. 

Agencies handle almost all things related to the surrogacy. They facilitate matching, coordinate attorneys for contracts, pre-screen surrogates, and help arrange clinic appointments. The intended parents and the surrogates can develop their relationships
without too many worries about finances or legal aspects. Many surrogates (especially first-timers) opt to go the agency route, as
usually it frees them from the worries of being financially "burned" by
IP's, where irresponsible IP's leave their surrogates with medical
bills or unpaid fees. Agencies are also reassuring for the IP's, as the surrogates have been pre-screened and are already dedicated to the process. Caveat – though agencies handwalk surrogates and intended parents through the process, not all agencies are equal; if you decide to go the agency route, you should do extensive reseach on costs, services offered, and track records. This is one instance where word-of-mouth reputation can be priceless.

In an independent journey, intended parents and surrogates do everything by themselves without the
use of a third party. Some websites, such as Surrogate Mothers Online (SMO), have classified ads where both surrogates and IPs can outline the type of person they're
looking for and the type of journey they want to have. Surros and
potential IP's (PIP's) scan the ads, and if one begins to tug at
their heartstrings, they can send an email and begin learning about one
another. Both parties have
complete freedom from start to finish in learning about each other and
there is a greater sense of control over what happens through the
process. A con to an independent journey are that it leaves both the PIP's and the surrogates more open to scammers who are not true to the
heart of the matter- having a baby and respecting all parties involved
in the process. With an independent journey, there also is no third party there
to handle uncomfortable situations between the IP's and surrogates, so
they have to handle any problems that may arise by themselves.

Which route is better – indy or agency? The answer to this question is purely a matter of personal preference and comfort levels. People who do no feel like they are good judges of character or have difficulties handling interpersonal conflicts might feel more comfortable with agencies. People who like to hold the deck versus having the cards dealt to them might prefer going indy. 

In all surrogacy situations – GS or TS, independent or agency –
potential surrogates and IPs have many other things to consider before even
attempting match. How much (or how little) will you feel
comfortable asking for/paying in compensation and fees? How much contact do you want to have
with the other party before, during, and after the birth of the child/ren? How do you feel about
selective reduction, and in which circumstances would you (or would you not) reduce or terminate? There are no right or wrong answers to these questions, but to have a good match, it is imperative that you know where you stand on these issues, and on which you have room for flexibility or none at all. The key to finding a good match is finding someone who shares the same mindset on as many issues as possible. Matching with someone who has polar opposite views on some of the heavier issues could potentially be a recipe for disaster.

Matching with someone who inherently shares a common vision is essential, so you shouldn't make the foray into something as challenging as surrogacy if you don't even know what to look for in the first place. The best advice I can give to anyone even considering surrogacy either
as an intended parent or surrogate is the old adage "look before you
leap." There is much to learn before you begin, and even more to learn after you begin. Sometimes, experience is not only the best teacher, but it is the only teacher. 

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Questions? Post them in the comments, and I'll either answer there or I'll let you know if I intend to cover your answer in more depth in a future post. Don't want to ask your question openly? My email is linked under my picture up there on the right. No questions? I'm a comment junkie, so drop me a line or two telling me how great I am. Just kidding. Sort-of.

16 Comments

  1. Mtnhighmama on August 12, 2008 at 8:56 pm

    Thanks, Moxie, for doing the work so I don’t have to. I’m just going to link to all of your Surrogacy 101 posts, until you tell me not to.
    Lots of love to you!



  2. Carrie on August 12, 2008 at 9:02 pm

    I’m excited to keep reading more about surrogacy, even though I have learned a GREAT deal from you already.



  3. Becky on August 12, 2008 at 9:49 pm

    I’ve been interested in the surrogacy process for ages. Thanks for clearing any questions I had up.



  4. JuliaKB on August 13, 2008 at 2:31 am

    You are great. Word.
    To show you how little I have thought about this, I just assumed that with IVF in the picture, TS is not done anymore, that it’s all gestational now. Silly, of course. But I can now conversely imagine that there are people who don’t know about gestational and think all surrogacy is traditional. Long way of saying I thank you for writing this, and am sure I will learn quite a bit from the series.



  5. Jendeis on August 13, 2008 at 8:35 am

    This comment serves to let you know how awesome you are. I so enjoyed reading this post. Never knew anything about surrogacy, so I loved learning these initial steps.



  6. Kari on August 13, 2008 at 8:52 am

    your doing a great job here, Moxie!!



  7. Kathy on August 13, 2008 at 12:08 pm

    So interesting Moxie! Thanks for sharing! With 3 FE left, GS is always in the back of my mind. My husband is not very open to it and since we were given the go ahead and told after delivering Molly that our doctors think my uterus could handle at least one more pregnancy, we may try again with them someday. That said, I so appreciate being able to learn about all of the options out there.
    Though we also discuss adoption from time to time, it seems to me that if we have 3 FE we should seriously consider using them one way or another before we would pursue adoption. That said there is a very small part of me that is scared that one of the FE could have some version of heart problems like Molly had (even though I understand is so very unlikely).
    Anyway, you are amazing! Thank you for educating me and others on a topic, that like so many related to IF and loss, is not nearly as simple as some might think.
    I came across Luna’s blog recently and she seems to be doing something similar in breaking down the adoption process from an emotional/what’s involved standpoint, which I also find so helpful and interesting. I don’t want to make any future decisions to consider adoption or GS lightly and Luna and you are helping to keep me from doing that.
    Okay, sorry for such a long comment here… I always have so much to say after reading your inspiring posts! (((HUGS)))



  8. Nikki on August 13, 2008 at 12:42 pm

    Thanks for the informational post Moxie. This was really educational!



  9. Eva on August 13, 2008 at 1:14 pm

    Hey, I am enjoying the 101 series. Check out my blog, I just gave you an award.



  10. anymommy on August 14, 2008 at 12:09 am

    So interesting. I am one who needed the basics. You are awesome, for being willing to carry a child for someone and for being willing to share your knowledge about the experience with others!



  11. Rayven, 2xGS on August 15, 2008 at 9:59 am

    LOL I’ve got tears in my eyes from laughing so hard at your “ad example”.
    And I love how you are stressing the importance of knowledge and research…..that is the best way to make sure you are not being taken advantage of!
    I wonder how many potential GS are in the premature matching phase before they realize there are shots involved!
    ~Rayven



  12. Jill on November 23, 2008 at 6:17 pm

    I hope I don’t come across as stupid…I’m a well educated woman, but this is all new for me.
    Are there ever any instances where a woman will simply become pregnant because you ‘hire’ her to do so and then place the baby to you through adoption?
    I know while typing this, it’s a ridiculous question. But our issues is we want a child that is either ours biologically (both of ours) or one that is completely not ours biologically.
    Fertility is an issue for us. His swimmers are slow and my eggs aren’t up to par.
    We have had one pregnancy that ended in losing the baby in the seventh month due to extreme preeclampsia…this after 7 years of TTC. We are advised to not get pregnant again as I nearly died and could literally die in another pregnancy.



  13. interestedinhelping on January 14, 2009 at 1:48 pm

    Just found this site. If you have not yet been advised of the “embroyo adoption” programs, you should check into it. Since you do not indicate any problems other than the quailty of your eggs, this may be a perfect solution for you and you husband since the embryo would not have a bio link to either of you. Good Luck!



  14. Jon on December 10, 2010 at 12:22 pm

    This is a great 101, Moxie!! I wish I had read it when I started my surrogacy journey. The only thing I would add to your TS vs. GS section is the importance of considering legal concerns. Many lawyers view TS as riskier than GS due to the biological link between surrogate and child in TS. Also, states can vary hugely in their legal treatment of TS versus GS. For example, Texas has excellent legal protections for intended parents with GS but not TS.



  15. Yesterday, Today, Tomorrow on February 1, 2012 at 10:18 pm

    […] of an hour answering various questions about legalities, matching, and various issues concerning independent vs. agency surrogacy arrangements. I hung up knowing that I’d helped a couple in their decision-making process and that […]



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